Real-life story - Zanzibar after F2
Find out more about Chris and his experience in Zanzibar.
It started with my indecision regarding my career path, and ended with me working for a non-governmental organisation called Health Improvement Project Zanzibar (HIPZ), in Makunduchi Hospital, trying to make a real and sustainable difference to the healthcare system of a small island off the east coast of Africa.
This came about through working for the urology team in Musgrove Park during my F1 year, where I met Mr MacDonagh, a consultant and friend who is the chairman of HIPZ.
Working in a low-resourced setting is so much more challenging than working in the NHS, and has given me a new perspective on the NHS and the UK. I’m sure my clinical judgement and skills will have improved, but the public health and management decisions I’m being exposed to are also making a lasting impression. These are experiences that a CT1 trainee in the UK would never be exposed to.
At the beginning it was very difficult seeing premature babies born only to die soon afterwards, I had frustrations at not being able to offer simple treatments such as inhalers for asthmatics, and I found it a real challenge working in a hospital that has a choice of four intravenous antibiotics and regularly runs out of two of them. I’ve seen and attempted to treat tetanus, only to have the patient self-discharge to a traditional healer. It was incredibly frustrating, yet the truth is there is no anti-tetanus immunoglobulin in Zanzibar, and I was only able to offer her diazepam to stop the spasms.
Yet now, four months later, I have seen premature babies surviving and being cared for appropriately because of a protocol I have designed and introduced. I’ve been working with the Ministry of Health to audit their drug supply and help find a solution to the drug shortages, and I’ve seen children I thought were going to die happily eating breakfast the following morning, by just giving them antibiotics, oxygen and fluids. It’s the most rewarding work I’ve ever done. I also now know what it is to be the most senior person in a team, and have had to make decisions about when to stop resuscitations, when to treat strokes with aspirin and no CT scan, and when to start anti-retroviral medication, when HIV tests are not available—decisions that are well above an ST1 responsibility in the UK.
Taking a year out of training is something I would recommend to any trainee, and taking time out after F2 is certainly not too early. The general experience and skills that your foundation jobs teach you are invaluable when you are faced with a ward round that can include any specialty.
The experience I have gained from my time in Zanzibar will no doubt hold me in good standing for the rest of my career and has already helped me obtain my first choice core medical training job back in the UK.